Asphidity Bags: A Student's Guide to Ethnocentric Healthcare

From: Greg Woods, National Black Nurses Association

Published: April 21, 2012

Greg Woods is a nursing student in the Accelerated Bachelors of Science in Nursing, Class of 2012.

Prior the 1950's, poliomyelitis was a problem for the
American population. Without a treatment, people began
to invent remedies to prevent, cure, or soothe this ailment.
African Americans used the Asphidity bag as a home remedy
to ward off polio. The Asphidity bag was a compilation of various
herbs and pungent substances that were thought to ward
off disease. The remedy began in the Appalachian Mountains
in the 18th and 19th century, became popular with African
Americans of the deep-south in the 20th century, and has now
changed forms again in the 21st century. Today, the African
American Asphidity bag has been transformed into a Ziploc
bag of pill bottles from the pharmacy that is utilized by patients
to verify medication lists with their healthcare provider. The
Asphidity bag is representative of African American generational
healthcare and how it has evolved from roots and berries,
animal and human rituals, and tribal medicine men, to African
Americans leading the health care revolution into the 21st century.
There are many African American cultural traditions that
have affected my personality and behavior. Witnessing these
traditions and their effect on the health of African Americans
has influenced my view on ethics, and therefore my future nursing
practice.

"Ethnomedicine is: local or indigenous knowledge and
methods for caring for, healing, and managing human lives
and livestock" (African Journal, 10/01/2009 to present, p.
1-100). The Asphidity bag was a collection of pungent herbs,
often including ginseng, pokeweed and yellow root (Kirkendall,
2010). It was used by my mother's family in the delta region
of Mississippi during the 1940's. My mother states "The bag
smelled terrible and all of my 12 brothers and sisters had to
wear the bag tied to a string hanging around our neck. I can
remember wearing the bag at age five to ward off polio and
children dying from polio" (E. Woods, personal communication,
February 6, 2012). The smell was terrible; however the
shortcoming of not wearing the bag was contracting polio.
The wisdom of the older generation was not questioned because
elders knew of other home remedies that worked. My
mother did not have a choice in wearing the Asphidity bag.
The thinking behind the Asphidity bag was to keep insects,
rodents, or other kids away that could possibly transmit the
disease. Many people of my mother's generation remember
the foul stench of the bag. They remember the horrible smell;
they remember polio; they remember the stories that their
parents and elders told them about the debilitating diseases
that the Asphidity bag was believed to prevent. Although the
effectiveness of this remedy is uncertain, it did provide peace
of mind to parents that their children and families would not
be devastated by polio. The small bag provided hope that
children would live a long healthy life to later take care of their
parents if the parents were to become infirmed.

The bag was also a knowledge transfer tool. The Asphidity
bag remedy was taught to the next generation along with the
stories of past relatives, cooking skills, methods of garden
and field work, and disciplinary approaches. The bag was
not only a defense against polio; it was a community tool of
communication. The Asphidity bag was the topic of many
community conversations because of the effect polio had on
families until mass immunizations occurred in the 1960's. The
impact of the polio vaccine was not apparent until the mid-
1950's when it was developed by Jonas Salk, MD (National
Museum of American History, Smithsonian Institute, n.d.). The
vaccine lowered the use of the Asphidity bag but failed to
demolish it due to cultural beliefs. It is common for African
Americans to relate culture and spirituality.

Strong beliefs in God, prayer, and spirituality are foundations
of African American culture and also have affected the
healthcare of African Americans. Most African Americans ask
for someone to pray or mention their name in church when
sick. Prayer for the ill has taken place for numerous years.
Even those that are not religious are coerced into accepting
prayer for themselves from others because people explore alternative
methods of healing when acutely ill. Even those that
do not have a strong belief in God will turn to prayer and alternative
therapies. As a student nurse, I know that healthcare
has a variety of components. These components concern
emotional spirituality and the physical treatment of an illness.
African Americans believe that a strong spiritual presence can
aid you through sickness as well as help you gain prosperity.
The Asphidity bag is a true symbol of African American
folklore that is valued as a long standing tradition of home
medicine. It is one of many southern traditions that have helped
to shape my personality and identity as an African American.

The Asphidity bag has left an indelible mark on my personality
and lifetime memories. I discovered this fact in nursing school
through personality testing and reflecting on experiences to
date. I asked myself: could it be that the Asphidity bag had a
role in how I scored on the MBTI personality test? Could the
stories about the bag and polio have altered my perception
of the world and how I interact with the people around me?
People build a multitude of experiences and memories as they
proceed through life that influences their reaction to various
stimuli. The stories of the Asphidity bag, my family, and interaction
with others have helped me to develop into the person that
I am today. Because the Asphidity bag affected all my relatives
that came before me; it had to have an impact on how I perceive
and judge the world around me.

Healthcare comes in many different forms and practices.
Asphidity bags, red yeast rice, cupping, garlic, and various
teas are several home remedies that have debatable effectiveness.
However, those that use these remedies perceive
them to be effective; Perception is reality. Perception is developed
from "the ways of becoming aware of things, people,
happenings, or ideas" and when "people differ systematically
in what they perceive… then it is only reasonable for them
to differ correspondingly in their interests, reactions, values,
motivations, and skills" (The Myers and Briggs Foundation,
n.d.). It is only necessary to believe that Asphidity bag-like
cures will work to experience their healing power.

There was once a long standing belief that a bag filled with
leaves and roots from the field could prevent or cure polio. It
sounds silly but isn't that what we do today. A pharmaceutical
company digs up roots in Africa or the Amazon, processes
those roots to products, and we rub them on our chests,
squeeze them into a pill, or apply them through the skin and
say, wow, I feel better. We take our Ziploc bag of pills to the
doctor so that he can verify the dose of medication that we
are taking and the physician says I am going to increase your
dose; however if we do not see any results, we might want to
consider some alternative therapies. Bring in your bag of medication
on your next visit and we will check your medical values
again. The Ziploc bag of medication that grandma takes to the
doctor is the Asphidity bag of the twenty first century.

I am learning that healthcare comes in many forms and
that some of these remedies work and some do not work.
However, I must respect all people, their cultural beliefs,
and the customs that they grew up with. Living in a diverse
region of the United States, I have seen kids turned upside
down to cure them of nausea, Chinese cupping to cure pain
syndromes, and blood-letting to release infection. These
methods are not so different from the Asphidity bag. They
are cultural healthcare practices that have been around for
hundreds, if not thousands of years and millions of people
have relied on their healthcare power.

The ANA Code of Ethics is fairly explicit in expectations for
the actions of a nurse. However, ANA Code of Ethics Provision
Two may be difficult to adhere to if my primary commitment is
to the patient. The difficulty lies in allowing patients to uphold
their cultural health care practices while I adhere to nursing
standards and hospital policies. Many cultural practices are
not acceptable in western health care environments under
the Code of Ethics Provisions 1-9. Practices such as Cupping
or Asphidity bags are no longer an acceptable means
of treatment. However, the client's cultural practices are extremely
important to healing physically and psychosocially.
Many practices such as the use of an Asphidity bag would
not be allowed in a U.S. clinic or hospital due to the smell
alone. Provision Two of the ANA Code of Ethics states, "The
nurse's primary commitment is to the patient… an individual,
group, family, or community" (American Nurses Association,
2001). There is conflict with supporting the patients' cultural
practices in a respectful manner and upholding standards set
forth by the nursing governing organizations. On one hand,
I need to care and support the patient's health and health
practices; on the other hand, I need to fulfill my pledged duty
to uphold the most basic regulations of nursing. My current
solution as a student nurse is to watch how experienced providers
deal with this issue and to formulate my own practices
that are congruent with the rules and regulations of my state
Board of Nursing and the ANA Ethical Provisions. As a nurse,
I am going to support the client's health maintenance and
recovery to the full extent of my practice.

The ANA Standards of Professional Performance would be
easier to adhere to when performing nursing duties in relationship
to client's cultural practices with the exception of Standard
VIII . ANA Standard of Professional Practice Standard VIII , Resource
Utilization, states "The nurse considers factors related
to safety, effectiveness, and cost in planning and delivering patient
care."(American Nurses Association [ANA], 2004) My ability
to deliver patient care will be affected by cultural practices
that are not congruent with the American standard of care. A
modicum must be reached so that patients can adhere to cultural
practices that fulfill their health care needs while receiving
appropriate medical and nursing care.

The Asphidity bag represents many things in African
American health care including home remedies, knowledge
transfer, and the spiritual power of healing. However, the
practical use of the bag in conjunction with western medicine
creates a dilemma in nursing care for various ethnicities
in the clinical setting. The difficulty lies in upholding nursing
standards while respecting cultural traditions. The bag has
evolved from a rural preventative measure for polio to a low
tech method of tracking medication usage. Although western
medicine is bound by rules, and regulations that provide a
standard of care; my first duty as a nurse is to improve the
health of clients through traditional and non-traditional sources
of appropriate care.